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Virologic and immunologic effectiveness of darunavir-based salvage therapy in HIV-1-infected adults in a Brazilian clinical practice setting: results of a multicenter and retrospective cohort study
Ribeiro, Karina Mota; Biscione, Fernando Martin; Westin, Mateus Rodrigues; Machado, Danielle Pessoa; Greco, Dirceu Bartolomeu; Tupinambas, Unai.
Affiliation
  • Ribeiro, Karina Mota; Federal University of Minas Gerais. Belo Horizonte. BR
  • Biscione, Fernando Martin; Federal University of Minas Gerais. Belo Horizonte. BR
  • Westin, Mateus Rodrigues; Federal University of Minas Gerais. Belo Horizonte. BR
  • Machado, Danielle Pessoa; Federal University of Minas Gerais. Belo Horizonte. BR
  • Greco, Dirceu Bartolomeu; Federal University of Minas Gerais. Belo Horizonte. BR
  • Tupinambas, Unai; Federal University of Minas Gerais. Belo Horizonte. BR
Braz. j. infect. dis ; Braz. j. infect. dis;18(1): 1-7, Jan-Feb/2014. tab
Article in En | LILACS | ID: lil-703060
Responsible library: BR1.1
ABSTRACT

Background:

Darunavir has been proven efficacious for antiretroviral-experienced HIV-1-infected patients in randomized trials. However, effectiveness of darunavir-based salvage therapy is understudied in routine care in Brazil.

Methods:

Retrospective cohort study of HIV-1-infected patients from three public referral centers in Belo Horizonte, who received a darunavir-based therapy between 2008 and 2010, after virologic failure. Primary endpoint was the proportion of patients with viral load <50 copies/mL at week 48. Change in CD4 cell count was also evaluated. Outcome measures were analyzed on an intent-to-treat basis applied to observational studies. Sensitivity analysis was conducted to evaluate the impact of missing data at week 48. Predictors of virologic failure were examined using rare-event, finite sample, bias-corrected logistic regression.

Results:

Among 108 patients, the median age was 44.2 years, and 72.2% were male. They had long-standing HIV-1 infection (median 11.6 years) and advanced disease (76.9% had an AIDS-defining event). All patients had previously received protease inhibitors and nucleoside reverse transcriptase inhibitors, 75% nonnucleoside reverse transcriptase inhibitors, and 4.6% enfuvirtide. The median length of protease inhibitor use was 8.9 years, and 90.8% of patients had prior exposure to unboosted protease inhibitor. Genotypic resistance profile showed a median of three primary protease inhibitor mutations and 10.2% had three or more darunavir resistance-associated mutations. Virologic success at week 48 was achieved by 78.7% (95% CI = 69.7–86%) of patients and mean CD4 cell count increase from baseline was 131.5 cells/μL (95% CI = 103.4–159.6). In multiple logistic regression analysis, higher baseline viral load (RR = 1.04 per 10,000 copies/mL increase; 95% CI = 1.01–1.09) and higher number of darunavir resistance-associated mutations (RR = 1.23 per each; 95% CI = 0.95–1.48) ...
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Full text: 1 Index: LILACS Main subject: Sulfonamides / HIV Infections / Salvage Therapy / Anti-HIV Agents Type of study: Etiology_studies / Evaluation_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Adult / Female / Humans / Male Country/Region as subject: America do sul / Brasil Language: En Journal: Braz. j. infect. dis Journal subject: DOENCAS TRANSMISSIVEIS Year: 2014 Type: Article

Full text: 1 Index: LILACS Main subject: Sulfonamides / HIV Infections / Salvage Therapy / Anti-HIV Agents Type of study: Etiology_studies / Evaluation_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Adult / Female / Humans / Male Country/Region as subject: America do sul / Brasil Language: En Journal: Braz. j. infect. dis Journal subject: DOENCAS TRANSMISSIVEIS Year: 2014 Type: Article